Flexor Hallucis Longus (FHL) Partial Rupture

Samson (not his real name) is a club soccer player who felt a sharp pain his right ankle injury during competition last Saturday. He felt pain in the inner aspect of the right ankle and could not 'push-off' to run or sprint after that. He used RICE treatment immediately after injury. The next morning he noticed a bluish discolouration of his hindfoot (see photo) due to dependent hematoma.

He saw me 2 days later and I had him dorsiflex his ankle and curl his toes downward against resistance (to strecth his FHL tendon). He grimaced in pain. He also had pain doing heel-lifts. I suspected a mild strain of his Tibialis Posterior tendon too.

He was seen by an experienced physiotherapist who told him he would be 'out-of-action' for at least a month. I told him that could be accurate but encouraged him to do some isometric exercises (without pain) and keep his fitness level by doing some aqua-jogging. He was prescribed some theraband resistance exercises and told to follow-up with his physiotherapist for electrotherapy.

For most practical purposes, he would need an ultrasound to evaluate the extent of the FHL partial rupture. Tendon partial ruptures may often require at least 12 weeks rehabilitation exercise followed by progressive return to play.